Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-09-5185 | CA |
NPI | 1003130113 |
---|---|
Provider Name | Mr. Kirk K Chang |
First Address | Fremont, CA 94538-3716 |
Second Address | Fremont, CA 94538-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 01/11/2016 |